Psychological interventions halve deaths and cardiovascular events in heart disease patients, according to research presented at the Acute Cardiac Care Congress 2013, the annual meeting of the Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC).

“The nurses on our coronary care unit observed that patients were less likely to have another heart attack, die, or return to the hospital when we talked to them about their treatment, played music for them or helped religious patients to say prayers,” said Dr. Zoi Aggelopoulou, a nurse and one of the study authors.

“It made us think that coronary heart disease is not just physical, but also has a psychological component.”

The current study was a meta-analysis of nine randomized controlled trials. The researchers evaluated whether psychological interventions could improve outcomes for coronary heart disease patients when combined with a conventional rehabilitation program.

The researchers found that the addition of psychological interventions reduced mortality and cardiovascular events by 55 percent after two years or more. The benefits were not significant during the first two years, according to the researchers.

“We found a huge benefit of psychological interventions after two years, with less patients dying or having a cardiovascular event and, therefore, fewer repeat hospital visits,” Aggelopoulou said.

“The interventions included talking to patients and their families about issues that were worrying them, relaxation exercise, music therapy, and helping them to say prayers.”

“Patients want to know what will happen to them when they leave the hospital, whether or not they can have sex, and how to take their medication,” she continued. “Our research shows that giving them information and providing reassurance decreases the chances of them dying or having another heart attack. Patients can help instigate this new culture of information by asking more questions and getting more involved in decisions about their treatment.”

Previous studies have shown that psychological factors — such as depression, social isolation and chronic stress, whether in a job, a marriage or from caregiving — may have an influence on the likelihood of having a heart attack in the first place, the researchers noted.

“The results of our study strengthen the evidence that psychological factors have a big role to play in heart disease,” Aggelopoulou said. “Not only do they impact on the risk of having a heart attack, but they also affect the future outlook of a patient who has had a cardiovascular event. This validates our view that cardiovascular disease is not just a physical disease but also has a substantial psychological component.”

The researchers recommend that psychological interventions be incorporated into patients’ rehabilitation.

“We can help our patients by simply talking to them or introducing new things like music therapy into our clinical practice,” Aggelopoulou said. “Coronary units are busy places — in Greece we sometimes have one to two nurses for 10 to 20 patients in the coronary care unit and we are under time pressure. But our finding that the addition of psychological support on top of physiological therapies reduces death and cardiovascular events by 55 percent should be a wake-up call that these interventions really do work. Preventing repeat hospital visits would free up the time we need to implement them.”